Definition

Myelitis, commonly referred to as transverse myelitis, is an inflammation of the spinal cord. This neurological disorder damages a component of the nerves called myelin. Transverse myelitis disrupts the transmission of signals from the spinal cord nerves to the rest of the body, causing pain, muscle weakness, paralysis, sensory issues, bladder dysfunction, and bowel disorders. The exact cause of myelitis is still unknown, but it is suspected to be triggered by factors such as infections or immune system disorders. Patients with myelitis can generally recover and walk normally again, but in severe cases, they may experience permanent paralysis.

The duration of this disease varies, ranging from 3-6 months to a lifetime. Myelitis can occur in both men and women and at all ages, although there is an increased incidence at ages 10, 20, and over 40. No significant increase in cases has been found in any particular race.

Causes

Recognizable symptoms of myelitis include sudden onset lower back pain. This condition can also affect other areas such as the chest, abdomen, or legs, depending on the part of the spinal cord that is affected. Sensory disturbances like burning, tingling, cold, or numbness are also found in myelitis patients. Motor symptoms vary depending on the location of the inflammation and which nerves are affected. If inflammation affects the cervical or neck nerves, all upper and lower limbs can be affected, causing weakness in the upper or lower limbs, and in some cases, paralysis. Neck nerve inflammation occurs in 20% of myelitis cases. Additionally, all patients usually experience varying degrees of bladder and bowel dysfunction. Symptoms can occur suddenly within a few hours or gradually over several days or weeks.

Risk factor

Myelitis can occur in all genders and ages. In many cases, the cause of the disease is idiopathic, meaning the exact cause is not known. However, inflammatory reactions are found in myelitis patients, with an increase in the immune protein IL-6.

Transverse myelitis can appear alongside other diseases. Therefore, if a patient previously has autoimmune diseases or central nervous system disorders, the existing inflammatory process in these diseases can also affect the spinal cord. Myelitis exists as a complication of these pre-existing diseases.

Diseases that can be risk factors for myelitis include neuromyelitis optica, multiple sclerosis, systemic lupus erythematosus, Sjogren's syndrome, sarcoidosis, and infections caused by viruses, bacteria, fungi, or parasites.

Symptoms

Recognizable symptoms of myelitis include sudden onset lower back pain. This condition can also affect other areas such as the chest, abdomen, or legs, depending on the part of the spinal cord that is affected. Sensory disturbances like burning, tingling, cold, or numbness are also found in myelitis patients. Motor symptoms vary depending on the location of the inflammation and which nerves are affected. If inflammation affects the cervical or neck nerves, all upper and lower limbs can be affected, causing weakness in the upper or lower limbs, and in some cases, paralysis. Neck nerve inflammation occurs in 20% of myelitis cases. Additionally, all patients usually experience varying degrees of bladder and bowel dysfunction. Symptoms can occur suddenly within a few hours or gradually over several days or weeks.

Diagnosis

To diagnose transverse myelitis, a thorough patient interview (anamnesis) about the symptoms experienced, the onset of the disease, the presence of other accompanying symptoms, and the patient's medical history is conducted. The doctor will also perform a nerve function examination. If indicated, or to determine the exact cause of the disease, additional tests can be performed to aid in diagnosis, such as MRI (Magnetic Resonance Imaging) scans to look for signs of inflammation in the spinal cord. A lumbar puncture, which involves taking a sample of spinal fluid for laboratory examination, and antibody tests to check for the possibility of neuromyelitis optica, can also be performed.

Management

Treatment for myelitis aims to relieve the symptoms. The therapy varies depending on the underlying disease. Medications used to treat myelitis include pain relievers, antiviral drugs, corticosteroids, and immunosuppressive drugs. Plasmapheresis therapy, which replaces blood plasma fluid with infusion fluid, is performed on patients with immune system disorders who do not respond to other treatments. Patients with myelitis are advised to undergo rehabilitation therapy, such as occupational therapy, to relearn basic skills so that they can carry out daily activities normally. Psychotherapy is also beneficial for addressing accompanying psychological issues like anxiety, depression, or sexual dysfunction. Physical therapy helps improve muscle strength and function and improve the patient's body movements.

Complications  

Common complications of myelitis include long-term pain that can interfere with daily activities and reduce quality of life. Stiffness or muscle cramps usually occur in the legs and buttocks. Partial or total paralysis can occur and persist after the initial symptoms. Other complications that can arise include sexual dysfunction, stress and anxiety, and depression due to chronic pain.

Prevention

Myelitis can be prevented by avoiding its causes. However, some causes are difficult to avoid. Preventing recurring episodes of the disease can be done by taking medications to maintain the immune system.

When to see a doctor?

It is recommended to see a doctor immediately if you experience pain, especially if accompanied by sensory and motor function disturbances. Some neurological disorders can cause sensory problems and urinary and bowel dysfunction. If spinal cord compression is found, surgery is usually required. Patients with multiple sclerosis, neuromyelitis optica, or lupus are advised to have regular check-ups with their doctor and follow their recommendations.

Looking for more information about other diseases? Click here!